title: Discrepancies between guidelines and clinical practice regarding prostate-specific antigen testing.
abstract: BACKGROUND
  Most guidelines recommend a judicious use of prostate-specific antigen (PSA) testing, whereas in daily practice, an increase of the incidence of PSA testing has been shown. Accurate up-to-date PSA test incidence rates are, however, lacking.
  
  
  OBJECTIVE
  To investigate the PSA test incidence rates in general practices over the past 10 years and to study which factors are associated with more frequent test use.
  
  
  METHODS
  We performed a retrospective cohort study using the routine health care database of the Julius General Practitioners Network from 2002 to 2011, of which data were available from more than 65 000 male patients. We calculated the annual incidence of PSA testing rates per 1000 person-years. Co-morbidities were analysed by means of International Classification of Primary Care codes. Relative risks (RRs) of having a PSA test were estimated as the ratio of observed rates of co-morbidities in men who underwent the test compared with a control group, and 95% confidence intervals (CI) were calculated.
  
  
  RESULTS
  From 2002 to 2011, the overall incidence rate of PSA testing in men ≥45 years increased almost 4-fold, from 15.5 to 54.3 per 1000 person-years. As from 2005, the incidence rates appear to increase more than those before 2005. Men with cardiovascular diseases, joint disorders, psychiatric diseases, respiratory diseases, overweight and diabetes mellitus were predisposed to undergo a PSA test, but men with urinary problems had the highest relative risk (RR 1.77, 95% CI 1.72-1.82).
  
  
  CONCLUSIONS
  From 2002 to 2011, PSA incidence testing rates increased, particularly in men with urinary symptoms and cardiovascular disease, despite several international guidelines that suggest a judicious use of PSA tests.
authors.affiliation: Department of Urology.
authors.forename: Esther Hj
authors.initials: EH
authors.lastname: Hamoen
authors.forename: Daphne Fm
authors.initials: DF
authors.lastname: Reukers
authors.forename: Mattijs E
authors.initials: ME
authors.lastname: Numans
authors.forename: Jelle O
authors.initials: JO
authors.lastname: Barentsz
authors.forename: J Alfred
authors.initials: JA
authors.lastname: Witjes
authors.forename: Maroeska M
authors.initials: MM
authors.lastname: Rovers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen
keywords: Diagnostic test; epidemiology; incidence; mass screening; prostate-specific antigen; prostatic neoplasms.